| Objective:1. To compare the short-term efficacy of obesity and type 2 diabetes mellitus(T2DM) of Laparoscopic sleeve gastrectomy(LSG) and Lparoscopic Roux-en-Y gastric bypass(LRYGB),respectively. 2. To analyze therapeutic effect and related complications of obesity and T2 DM using LSG and LRYGB.Methods:Related literatures about LSG and Roux-en-Y gastric bypass(GBP)were searched by computer in Pub Med、EMbase、Cochrane Library、Web of science,Wan Fang、VIP、CBM and CNKI databases. The followed words: bariatric surgery,obesity surgery, Sleeve Gastrectomy, gastric bypass, randomized controlled trial,Roux- en-Y gastric bypass, LRYGB and LSG were used as key words. The literatures between Jan.2011 to Dec.2015 related with LSG and LRYGB for the treatment of the obesity and T2 DM were collected, and then the postoperative blood glucose, Glycated hemoglobin, body mass index(BMI) and related complications were compared.Inclusion and exclusion criteria to select literatures were set up.The datas and literatures were analyzed by two researchers, and performed strict quality evaluation and data extraction for the quality of the literature.All the datas were evaluated and analyzed by Rev Man 5.30 software.Results:Fifteen articles were involved including eight randomized controlled trials(RCTs). The results of meta-analysis showed that there were differences between before and after LSG in level of fasting plasma glucose [MD=2.02,95%CI(0.85,3.18),P=0.0007],Glycated hemoglobin [MD=1.64,95%CI(0.57,2.71),P=0.003] and BMI[MD=11.08, 95%CI(9.81,12.35),P<0.01], but low-density lipoprotein(LDL)was no significant difference [MD=0.70,95%CI(-0.67, 2.08), P=0.31]. There were differences between before and after LRYGB in level of fasting plasma glucose [MD=2.72, 95%CI(1.73,3.71),P < 0.01], Glycated hemoglobin [MD=1.44,95%CI(0.58,2.30),P=0.001], BMI [MD=13.22,95%CI(11.21,15.23),P < 0.01] and LDL [MD=1.66,95%CI(1.31,2.00),P < 0.01].There was no significant differences between the LSG group and LRYGB group in body mass index after 1 year [MD=0.70,95%CI(-1.01,2.40),P=0.58],3 years [MD=0.65,95%CI(-0.71,2.01), P=0.85] and 5 years [MD=1.13,95%CI(-0.51,277), P=0.78],level of fasting plasma glucose [MD=-0.19,95%CI(-0.58,0.20), P=0.74]and Glycated hemoglobin [MD=0.12,95%CI(-0.09,0.32), P=0.28] after1 year, gastric fistula [OR=0.98,95%CI(0.54,1.79),P=0.64], bleeding [OR=0.87, 95%CI(0.12,6.54),P=0.89].However,the LSG group had lower postoperative complication rate [OR=0.25,95 % CI(0.13,0.49), P < 0.01] and shorter operation time[MD=-46.24,95%CI(-64.62,-27.91), P<0.01] than that of the LRYGB group.Conclusion : 1. LSG and LRYGB both are effective approaches in treatment of obesity and T2 DM, and these two methods are curative.2. LSG has no significant difference in postoperative weight loss of one year, lower fasting glucose and glycosylated hemoglobin compared to LRYGB, and postoperative BMI of 3 and 5years has the same result.LSG has the same effect with LRYGB in reducing the level of fasting plasma glucose and weight loss, while the difference between LSG and LRYGB are that LDL is the significantly reduced in LRYGB group.Beyond that,surgical operation of LSG is relatively simple, and LSG has lower postoperative complication rate and shorter operation time with more advantages than LRYGB. |
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